rTAPP FOR THE SIMULTANEOUS TREATMENT OF RECURRENT BILATERAL SPIGELIAN AND INGUINAL HERNIAS

Abstract Aim Spigelian hernias are a rare variant of primary ventral hernias. Minimally invasive surgery has allowed new treatment techniques. The objective of this video is to demonstrate the advantages of robotic TAPP for the single-stage treatment of this type of hernia in a complex case of recurrence and bilaterality associated with inguinal hernia. Methods A 70-year-old patient with a history of bilateral Lichtenstein inguinal hernioplasty and right Spiegel subaponeurotic hernioplasty presented with bilateral abdominal pain and left inguinal mass. CT: Bilateral spigelian and left inguinal hernia. Technique The DaVinci Xi system is docked with 3 trocars located in the epigastrium and both hypochondria. Dissection of the preperitoneal plane of the right flank is performed with reduction of the recurrent Spiegel hernia, closure of the defect with VLock suture and placement of preperitoneal polypropylene mesh. The peritoneal section is closed with VLock running suture. On the right side, the same technique is performed, progressing distally until the dissection and reduction of the inguinal hernia, treating the two hernias together with a single mesh placed preperitoneally. Conclusion The robotic TAPP approach allows for single-stage resolution of various abdominal wall hernias. The correct visualization of the hernia contents, the minimum approach and repair without tension allows the rapid recovery of the patient.